Gillis Andrea, Wang Rongzhi, Zmijewski Polina V, McLeod M Chandler, Ramonell Kimberly, Fazendin Jessica, Chen Herbert, Lindeman Brenessa
Department of General Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Surgery, University of Pittsburgh, PA, USA.
Heliyon. 2024 May 31;10(11):e32244. doi: 10.1016/j.heliyon.2024.e32244. eCollection 2024 Jun 15.
Hyperparathyroidism is common with African American patients historically experiencing disparate outcomes. With a comprehensive outreach program and systematic treatment plans, we sought to evaluate our institution's ability to reduce disparities in hyperparathyroidism.
We performed a retrospective review of prospectively collected data at a single medical center for all patients undergoing parathyroidectomy by endocrine surgeons from 2015 to 2021 for primary (PHPT) and tertiary (THPT) hyperparathyroidism. Patient demographics, pre-and post-operative clinical and biochemical data were collected and analyzed by race.
Of the 757 patients included, 675 patients had PHPT with 135 (20 %) African-American (AA) and 528(78 %) female. Of 82 patients with THPT, 44 (53 %) were AA and 34 (32 %) were female. AA patients were younger than Caucasian (CA) patients with a mean age (±SD) of 56 ± 15 vs 60 ± 14 years in PHPT (p < 0.01) and 50 ± 10 vs 55 ± 10 years in THPT (p = 0.02).Median (IQR) preoperative PTH was higher in AA with PHPT 134 (97-190) vs 102 (75-144) pg/mL (p < 0.01) and in AA with THPT 285 (189-544) vs 218 (145-293) (p = 0.01) pg/mL. AA PHPT patients had significantly higher preoperative mean (±SD) calcium levels 10.9 ± 0.8 vs 10.6 ± 0.8 mg/dL(p < 0.001). Biochemical cure rates at 6 months and complication rates were not different between races.
AA patients with PHPT and THPT disease experienced similar cure rates to their CA counterparts despite having a more severe biochemical disease. Health care disparities may be ameliorated with treatment by high volume surgeons embedded in a comprehensive health care system.
甲状旁腺功能亢进症很常见，非裔美国患者历来预后存在差异。通过全面的外展计划和系统的治疗方案，我们试图评估我们机构减少甲状旁腺功能亢进症差异的能力。
我们对一家单一医疗中心前瞻性收集的数据进行了回顾性分析，这些数据来自2015年至2021年由内分泌外科医生为原发性（PHPT）和三发性（THPT）甲状旁腺功能亢进症患者进行甲状旁腺切除术的所有患者。收集患者人口统计学资料、术前和术后临床及生化数据，并按种族进行分析。
在纳入的757例患者中，675例患有PHPT，其中135例（20%）为非裔美国人（AA），528例（78%）为女性。在82例THPT患者中，44例（53%）为AA，34例（32%）为女性。AA患者比白种人（CA）患者年轻，PHPT患者的平均年龄（±标准差）为56±15岁，而CA患者为60±14岁（p<0.01）；THPT患者中，AA患者平均年龄为50±10岁，CA患者为55±10岁（p=0.02）。PHPT的AA患者术前甲状旁腺激素（PTH）中位数（四分位间距）较高，为134（97-190）pg/mL，而CA患者为102（75-144）pg/mL（p<0.01）；THPT的AA患者术前PTH为285（189-544）pg/mL，CA患者为218（145-293）pg/mL（p=0.01）。PHPT的AA患者术前平均（±标准差）血钙水平显著更高，为10.9±0.8mg/dL，而CA患者为10.6±0.8mg/dL（p<0.001）。6个月时的生化治愈率和并发症发生率在不同种族之间没有差异。
患有PHPT和THPT疾病的AA患者尽管生化疾病更严重，但其治愈率与CA患者相似。在综合医疗保健系统中，由经验丰富的外科医生进行治疗可能会改善医疗保健差异。
